Tag: regulatory

While lawmakers are out of session, work continues on the regulatory front with two initiatives: Medicaid Reform and Licensure Rules Rewrites. First, Secretary Mandy Cohen has been hosting stakeholder meetings and making the rounds with lawmakers garnering support for her Medicaid Reform Bill. The Department is attempting to align physical health and behavioral health services by creating Special Needs Plans. BAYADA has been invited to work with Medicaid and other stakeholders on this matter. We will ensure level of services and provider adequacy remains central in the program design and waiver application. Second, the Division of Health Service Regulations (DHSR) has published for public comment their proposed changes to the Home Care Licensure Rules. The Government Affairs Office (GAO) has convened a review team of BAYADA experts to draft our formal comments, due August 15.

On the advocacy front, our Hearts for Home Care Ambassadors will commence their summer outreach efforts with lawmakers.

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

Following compelling testimony by clients Nancy and Christopher Lemus, Delaware Association for Home and Community-based Care (DAHCC) President Bob Bird, Delaware Pediatrics (DP) Associate Director Mandy Brady, and myself, the House Health & Human Development Committee passed a bill that would set a minimum reimbursement rate paid by Medicaid managed care organizations (MCOs) to home health care providers for skilled nursing services. Representatives asked probing questions, sparking true debate over the measure. The vote was 10-0 with 4 additional members absent. The bill must still pass the full House, the Senate Health, Children & Social Services Committee, and the full Senate. The legislature closes on June 30. If this bill passes, MCOs would not be able to pay any less than the Department of Health and Social Services (DHSS) pays for the same care, giving DHSS the ability to ensure access to needed services.

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

Following a concerted education effort and participation by many members of the home health care industry, HB200, which sets a “rate floor” for skilled nursing paid by Medicaid managed care, has been introduced. Nine members of the legislature have said that home health care matters to them, and are sponsoring the bill. Every home health care provider who answered an industry-wide survey said their number of unfilled hours has increased over last year. HB200 would go a long way toward ensuring access to skilled nursing for home health care clients across the state. If the bill becomes law, managed care organizations would not be able to pay less than the Department of Health and Social Services pays directly for similar services.

The Deputy Secretary of the Office of Developmental Programs (ODP) Nancy Thaler released a statement that she would establish one statewide rate for services and that all rates would go up. This is a welcomed move as it also supports our legislative priority of establishing one statewide rate and increasing the personal assistant services rate to $20.58. We plan to ensure our legislative champions know about this move in our upcoming meetings.

Submitted by Shannon Gahs, Associate Director, DE Government Affairs (GAO)

The Governor’s Commission on Building Access to Community-based Services, Health Committee, determined its new agenda last week. With support of representatives from Family Voices and Family SHADE, the committee will work on ensuring that all Delawareans eligible for community-based services know what they qualify for and how to access care. At the suggestion of a representative from Nemours A.I. DuPont Hospital for Children and me, the committee will also be working to ensure that all Delawareans, especially children, have access to quality home health care.

Last week, during the Pennsylvania Homecare Association Annual Conference, Deputy Secretary for the Office of Long-Term Living (OLTL) Jen Burnett announced Managed Care Organizations (MCOs) will be required to reimburse providers at least the state posted fee-for-service reimbursement rate for personal assistant services. This “rate floor” will be in effect for the first 36 months post transition of each region. After the announcement, I had the opportunity to speak with Deputy Secretary Burnett, and she stated the reason OLTL made that decision was to provide stability for providers. During our conversation, I asked that her office consider extending the temporary rate floor to registered nurse (RN) and licensed practical nurse (LPN) services as well for the same reason. She invited us to meet with her formally to discuss. BAYADA’s Government Affairs Office (GAO) will work to set up a meeting with OLTL to lobby for the inclusion of RN and LPN services in the 36-month rate floor.

Each year the PA Department of Aging and the Pennsylvania Homecare Association (PHA) request nominations for the Direct Care Worker (DCW) of the Year. The DCW is an individual who goes above and beyond in their work and provides essential services to older Pennsylvanians and disabled adults.

This year there were over 160 nominations. BAYADA nominated 21 aides from our offices.

The award was given at PHA’s Direct Care Worker Forum in Harrisburg. Each aide that was nominated was invited to attend. The day consisted of professional development, a motivational speaker and a DCW survey on the challenges of the profession.

Towards the end of the event PA Department of Aging Secretary named BAYADA Philadelphia Corporation of Aging –West Home Health Aide Anne Pannone as the DCW of the year.

Anne will be recognized again at the PHA Annual Conference in the Poconos.

As many may know by now, the Department of Human Services recently announced they would delay and stagger the implementation of the new HealthChoices contracts. This was due to several bid protests and court battles currently working its way through the system.

This pushes the implementation to January of 2018. The current plan is to rollout the new HealthChoices contracts:

January 2018 Southwest & Northwest

March 2018 Northeast

July 2018 Southeast

January 2019 Lehigh/Capitol

This will make the staggered roll-out similar to the Community HealthChoices implementation plan.

But why the delay?

Simply put, there are billions of dollars at stake. The total funds available for HealthChoices are estimated to be over $12 billion. So those organizations that do not win bids miss out on one of the largest state contracts in the US.

Number of Regions in Old Contract

Number of Regions in New Contract

Centene

3

3

Health Partners

1

2

United

5

0

UPMC for You

5

4

Keystone

1

1

Gateway

2

5

Aetna

1

0

AmeriHealth

3

2

This could also be one of the reasons why DHS is staggering the roll out. With the staggered roll out the Lehigh Capitol region transitions in January of 2019. This means that United and Amerihealth will get to keep their consumers for almost two years longer than originally anticipated.

We are still expecting court challenges which could delay the implementation further.

For your reference, I have included charts which details what MCOs were awarded what regions and the number of regions they were awarded.

GAO continues to monitor this situation and will update the pediatric leadership as more information becomes available.

On April 6th BAYADA Leaders, including Practice President David Baiada,Chief Government Affairs Officer Dave Totaro, Assistive Care State Programs (ACSP) Practice Leader Eric Thul, Crocus Division Director Kevin Kuzmick, PCA Director Donna Russell-Kane, and I met with Senator and Gubernatorial Candidate Scott Wagner. This meeting was a result of a previous meeting that Dave Totaro and I had with Senator Wagner introducing the need to increase the personal assistant services (PAS) rate under the Office of Long-Term Living (OLTL) by an average of 10%.

The meeting took place in the BAYADA PCA office. We discussed the ACSP business, its challenges and advantages, as well as the wage issues associated with the program. Senator Wagner also heard first-hand about what it’s like to be a home health aide from PA Department of Aging’s Direct Care Worker of the Year, BAYADA aide Anne Pannone.

The conversation was productive, and Senator Wagner understands the value of home care and the cost savings it can provide to the Commonwealth. He has agreed to help us in our legislative priority of increasing the PAS rates and would also like to spend a day in the field with Anne to see the work first-hand.

GAO, working collaboratively with the Association for Home & Hospice Care (AHHC) and Matt Wolfe, AHHC’s legal counsel, continues to work with Medicaid Director Dave Richard and key lawmakers, including Senators Ralph Hise and Tommy Tucker, and Representatives Nelson Dollar and Josh Dobson to resolve a technical issue with the retroactive rate increase for CAP-C nursing. As you may recall the General Assembly appropriated funds last session to increase the nursing rate by 10% effective July 1, 2016. The Department is supportive and is seeking a solution with the Centers for Medicare & Medicaid Services (CMS). GAO will keep you informed as things develop.